I wonder which will happen first: discovery of effective small-molecule drugs in this class, or improvements of peptide manufacturing to the point that cheap generics become possible. There are only 7 years left on the semaglutide patent but its manufacturing is currently so complicated that I don't expect really cheap generics after patent expiration.

I am not familiar with the specifics of manufacturing these drugs, but peptide molecules have been synthesized for decades. What makes these special?

Considering the high prices of the marketed product, I would dispute the idea that generic manufacturers will not leap at the chance to get a taste. Even if it is technically complex, they have years to perfect a recipe, get it GMP qualified, and on shelves the day patents expire.

My understanding is that the manufacturing costs have nothing whatsoever to do with why they’re so expensive. It’s already damn near aspirin-cheap to make.

Correct, cost is ~$5 for a month supply, and could be made for as low as 89 cents.

https://doi.org/10.1001/jamanetworkopen.2024.3474

https://www.fastcompany.com/91071415/your-1000-per-month-oze...

Unfortunately, the story for people who discontinue the drug is less rosey. Many regain some or all of the weight lost; it appears to be a temporary alternative to stomach surgery.

Does this happen any more often than when people lose weight by other means? I was under the impression that something like 90-95% of people who lose significant weight gain a lot of it back.

Other means have fewer side effects and cost insurance companies less, meaning they cost you less.

Over-priced temporary fixes should be the choice of last resort, not the first one.

The overpricing is not inherent to the manufacturing of these drugs as far as I understand, it's an artifact of the American healthcare system.

You know what else is a temporary fix? Vitamin C for scurvy. Your body does not produce it endogenously. You are already a lifelong patient -- all humans are -- and it just so happens that the medication to treat it is part of your diet.

Targeted gene therapy is the end goal, versus chronic management. We bug fix the human. Think of this as pharma print statement debugging.

In the interim, the drug helps those in need of intervention.

https://www.fractyl.com/fractyl-health-demonstrates-signific...

https://www.remain1study.com/remain-1-study/

The story for people who discontinue drugs for hypertension is less rosy too.

What else will we see? More bowel obstructions?